Acute pulmonary embolism can range from being completely asymptomatic to causing life-threatening events, which underscores the importance of effective risk stratification. Intermediate-risk patients represent a distinct subgroup characterized by specific clinical, laboratory, and imaging features. Although the majority have favorable outcomes, a significant proportion may still experience adverse events, presenting an ongoing challenge in determining the optimal therapeutic approach. This comprehensive review explores the characteristics of intermediate-risk pulmonary embolism patients, focusing on key diagnostic and prognostic factors, current treatment practices, and the evolving role of novel, specifically catheter-directed interventions. We also provide an overview of current guideline recommendations and discuss recent advancements in the field.